With the firehose torrent of stories involving science, medicine, denialism, and antivaccine misinformation that assault my senses and social media every day, it is not surprising that there are a fair number of stories that are definitely “in my lane,” so to speak, but about which I somehow never manage to apply my characteristic helping of Insolence, either Respectful or not-so-Respectful. It happens. It’s been happening for the entire 15 years that I’ve been engaged in this pursuit. It will continue to happen, certainly more often now that I’ve cut back from a manic five or six posts a week to a mor manageable two to four. Even so, thankfully I sometimes get a second chance to tackle a topic that I missed, and so it is today. That’s why I thank Cincinnati.com for doing a followup story about a cancer center in Cincinnati accepting a gift from a dubious multilevel marketing company to open an “integrative oncology center.” I’m referring to an article from Sunday that I saw yesterday entitled Essential oils company gifts $5 million to St. Elizabeth; social media criticism follows months later. The company is dōTERRA, and the hospital is St. Elizabeth Healthcare. I would have written about this for yesterday, but I had to wait for a Twitter follower (thanks, @KimWahlman!) who happened to have a subscription to send me the text, hence the delay.
St. Elizabeth Healthcare accepts a donation from dōTERRA
Let’s start with this story, and I’ll fill in the background as I go along:
In accepting a $5 million gift from a Utah company that sells essential oils, St. Elizabeth Healthcare announced that it aims to explore untraditional therapies at its new cancer center. But social media commenters accuse the Edgewood system of selling out to a multilevel marketing firm.
month, dozens of Reddit, Twitter and YouTube participants raised an online clamor over the $5 million gift, the biggest ever to St. Elizabeth’s foundation, from doTerra, a Pleasant Grove, Utah, firm that calls itself the world’s largest producer and vendor of essential oils.
This is not a good look. First of all, although essential oils might smell pleasant and could potentially make the hospital experience slightly less unpleasant, there is no good evidence supporting the many claims made by dōTerra for its oils. If you don’t believe me, just look at the statement on its website: “These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.” This is what we in the biz call the Quack Miranda Warning, a name coined by my good bud Dr. Peter Lipson many years ago. Basically, it’s a get-out-of-jail-free card used by sellers of unproven and quack remedies based on the Dietary Supplement Health and Education Act of 1994 (DSHEA). The DSHEA is law that basically regulates dietary supplements (and many essential oils are ingested orally as supplements) as food rather than medicine and does not require them to be tested for safety or efficacy before they can be marketed as long as no claims for treating disease are made. While this would make sense if such supplements were marketed solely as food or for nutrition, as regular readers of this blog know, this is not the case. Worse, the DSHEA carves out a separate category of health claims that can be made for supplements, specifically so-called “structure-function” claims; that is, claims that the supplement somehow supports the structure or function of the body in some way—again, as long as no specific claims about disease are made.
The DSHEA is how we get claims that various supplements “boost the immune system” or “support prostate health” or “aids digestion,” almost always with a quack Miranda warning following somewhere in in the ad or on the website. Indeed, dōTERRA’s free ebook claims:
When applied safely and properly, internal use of essential oils can be just as beneficial as aromatic and topical use. In some cases, internal use can provide unique benefits that the other two application methods simply cannot offer. Although some are skeptical about the efficacy of internal use, there is research to support the potential benefits of consuming essential oils internally. Among many benefits, essential oils can be used internally to support gastrointestinal health, maintain healthy immune function, promote healthy cell function, provide the body with internal cleaning benefits, and more.
These claims are the very definition of vague “structure-function” claims that are meant as a “nudge, nudge, wink, wink” claim for health benefits permitted under the DSHEA.
As for dōTERRA itself as a company, it’s a multilevel marketing company (i.e., a thinly disguised pyramid scheme in my opinion, although the FTC has never seriously investigated this company) that markets its essential oils based on dubious claims. (More on that later.) It is not a company that any reputable hospital, medical school, or medical center should ever affiliate with for anything, much less name a center after. Did I say, “Name a center after?” Oh, yes. Yes, I did. It’s mentioned in the Cincinatti.com story, but let’s look at the original press release on the dōTERRA website:
St. Elizabeth Healthcare announces a partnership with doTERRA International, an integrative health and wellness company and the world leader in the Global Aromatherapy and Essential Oils market. doTERRA will play a foundational role in the development and implementation of the forthcoming Center for Integrative Oncology within St. Elizabeth’s new Cancer Center in Edgewood opening in the fall of 2020.
“When the St. Elizabeth Cancer Center opens next fall, it will include nearly an entire floor of the building that is dedicated to the holistic, patient-centered approach to care known as integrative oncology,” shared Garren Colvin, President and Chief Executive Officer of St. Elizabeth Healthcare. “We want patients (and their caregivers) to have as much support and access to resources as possible under one roof.”
The doTERRA Center for Integrative Oncology will be more than 8,400 square feet on the first floor of the St. Elizabeth Cancer Center. The Center will provide a calming space with holistic care options to complement St. Elizabeth’s comprehensive medical care, including the use of doTERRA essential oils and aromatherapy, yoga, meditation and a spa-like atmosphere for patients undergoing cancer treatment. Additionally, experts at St. Elizabeth Healthcare will be conducting clinical trials related to complementary and alternative medicine, providing evidence-based options that may help patients better manage symptoms.
It’s rather interesting to me that St. Elizabeth sold its medical and scientific soul for a mere $5 million. Sure, $5 million sounds like a lot of money. It’s a sizable contribution. However, after using it to set up the dōTERRA Center for Integrative Oncology, there won’t be a lot left to do all these clinical trials of “complementary and alternative medicine.” As anyone who’s ever been involved in clinical trials knows, serious randomized clinical trials that are sufficiently powered to produce statistically significant results compared to placebo controls are expensive. Of course, dōTERRA and St. Elizabeth could be planning on doing a bunch of crappy “pragmatic” trials or underpowered trials for “proof-principle,” but even then whatever’s left over from the $5 million after however much is earmarked for construction is used up won’t go very far.
Why would St. Elizabeth accept a donation from an essential oils MLM company?
How did this come about, though? This part of the press release suggests why St. Elizabeth might have been so receptive to the idea:
St. Elizabeth Healthcare operates five facilities throughout Northern Kentucky and more than 115 primary care and specialty office locations in Kentucky, Indiana and Ohio. A member of the Mayo Clinic Care Network, St. Elizabeth is a mission-based organization committed to improving the health of the communities it serves, providing more than $117 million in uncompensated care and benefit to the community in 2017.
Regular readers of this blog and others know that the Mayo Clinic has, alas, along with Memorial Sloan-Kettering Cancer Center, the University of Texas-M.D. Anderson Cancer, Center, and many other academic medical centers, dived head-first into the world of “integrative medicine” (or, as I like to call it, “integrating” quackery with medicine).
As for how this happened, follow the press release:
doTERRA first learned of the St. Elizabeth Cancer Center from one of its wellness advocates who was a former patient of Dr. Flora and is now a cancer survivor. Inspired by St. Elizabeth’s personal and integrative approach to medicine, which aligns with doTERRA’s philosophy and focus on wellness and addressing the needs of the whole person, doTERRA made a generous donation of $5 million to the St. Elizabeth Foundation Cancer Center Community Campaign—the largest corporate donation in St. Elizabeth Foundation’s 30 year history. This donation symbolizes the start of a synergistic partnership between the two organizations.
St. Elizabeth even made this slick video:
Given that, even though it’s the largest corporate contribution ever received by St. Elizabeth, $5 is not a lot of money to do clinical trials and build medical programs; so of course it’s the “start of a synergistic partnership.” Sadly, the synergy will be to aid dōTERRA in selling its expensive smelly oils and to “integrate” quackery more deeply into
St. Elizabeth’s “integrative oncology” program. Dr. Doug Flora, even inadvertently (albeit obliquely) admits that it’s all about the marketing:
Dr. Doug Flora, executive medical director of oncology services at St. Elizabeth, said St. E is responding to changes in the way patients and their families want and need to be treated.
“Fifty percent of all cancer patients report using some alternative or complementary medicine,” Dr. Flora said. “The number gets as high as 80 percent when you survey women with breast cancer.”
Dr. Brannick Riggs, vice president of healthcare initiatives and chief medical director of doTERRA’s medical clinic, said complementary medicine is critical to treatment and recovery.
“It’s a way of rebuilding the patient after the treatment,” Dr. Riggs said. “We know that traditional treatment by design wreaks some havoc on the human body. We hope that these modalities help support the rebuilding of a life afterward.”
Translation: We’re giving the people what they want. We’re keeping the customer satisfied, science be damned.
dōTERRA: An MLM company selling dubious products
So what’s the harm, you might ask? After all, “essential oils” and aromatherapy are harmless woo, aren’t they? Well, let’s take a look at how dōTERRA has marketed its essential oils. This Mother Jones story from two years ago notes how dōTERRA and other MLM companies selling essential oils “got the autism community hooked on essential oils.” It begins with the story of a young mother named Cheryl Walser whose first son Ethan (born when she was 19) was diagnosed with autism at a very young age:
Ethan was diagnosed with autism. “I felt incredibly alone, and so ashamed,” Walser, now 33, recalls. “I believed that I had done something to cause it, and I had no idea how to fix it.”
The next several years were a blur of doctors’ appointments, special diets, and therapy. Some of the treatments helped, but “it felt like two steps forward, three steps back,” Walser recalls. When Ethan was five, a friend invited her to an evening class she taught about so-called essential oils made by a Utah-based company called DoTerra. The friend thought the oils could help Ethan.
This was the first step that Walser took on the road to becoming a dōTERRA “consultant” or, as dōTERRA likes to call them, a “Wellness Advocate”:
This transition from consumer to salesperson is common in the world of DoTerra, a multilevel marketing (MLM) company that works like the Tupperware parties of old: Salespeople invite friends to their homes for sales events disguised as parties or classes. They give a spiel about the product, maybe hand out a few free samples, and then offer their guests the opportunity to buy. Selling is good, but recruiting new salespeople is better: If you convince a friend to sell DoTerra products, you take a commission on every sale she makes. If she recruits her friends, you then get a cut of their sales, too. This model has done well for the company, which has gross annual revenues in excess of $1.5 billion.
Kiera Butler, the reporter who wrote this story, noted that some parents were spending hundreds of dollars a month on essential oils for their autistic children, noting also tha there are dozens of essential oil groups for parents of children on the spectrum. One group, he group Autism, ADHD, and Essential Oils, for example, had more than 19,000 members. (It has over 28,000 members today.) In any event, like any good MLM scheme, the real way to make a lot of money is to recruit a lot of other people to sell product. Of course, like any good pyramid scheme, that means that only the people who get in early make a lot of money. The lower down the pyramid you go, the harder it is to make any money because you’re giving a cut of your sales to those above you who recruited you and to those who recruited them (and so on, up to seven levels deep), especially since, conveniently enough, the company requires its salespeople to spend at least $100 a month on DoTerra products in order to qualify for sales commissions. As admitted even by a source that deludes itself into thinking that dōTERRA is not a pyramid scheme, recruiting new Wellness Advocates is where the big money is; it’s incredibly difficult to make very much money at all just selling product.
Indeed, the single most compelling benefit for dōTERRA of having a cancer center name its “integrative oncology” center after the company is that it will likely facilitate recruiting of new salespeople who are cancer patients or relatives of cancer patients. But, says Dr. Russell Osguthorpe, doTerra’s chief medical officer:
“We’re not selling anything in that space at all, quite the opposite. We agreed early on, we would not sell in that space. It’s a place of healing, not a place of business.”
This is, of course, very clever. Patients receive essential oils at the dōTERRA Center for Integrative Oncology at St. Elizabeth, but they can’t buy more of the oils there because the cancer center won’t be selling them. So what do they do? They seek out a dōTERRA consultant/Wellness Advocate to buy more of them, which then makes them more likely to be recruited as Wellness Advocates themselves to sell the company’s products. The hospital benefits by being able to appear to keep its hands clean by being able to say truthfully that it doesn’t profit by selling essential oils, and the company benefits from a rich new dedicated group of customers and Wellness Advocates. Synergistic, indeed! I am, however, confused about the “no selling” pledge by St. Elizabeth, given that this news article from October quotes Garren Colvin, president and CEO of St. Elizabeth Healthcare, as saying that “we have sold dōTERRA oils in our gift shop for quite a while.”
The Cincinnati.com article notes that dōTERRA has come under FDA scrutiny in the past. For instance, in 2014, the FDA issued a warning letter:
In September 2014, the FDA sent doTerra a warning that some salespeople, who doTerra calls “wellness advocates,” were telling customers that essential oils could treat or cure conditions including the Ebola virus.
Osguthorpe and other doTerra officials say the company has worked with the FDA since then to correct sales language and train wellness advocates to steer clear of explicit promises. The FDA has taken no further action since the 2014 letter.
Here’s the FDA warning letter to dōTERRA, dated September 22, 2014. It notes that dōTERRA Wellness Advocates made claims including:
- “Melaleuca (also known as tea tree oil) has been clinically shown to inhibit the replication of the influenza virus. Some of melaleuca’s primary uses include . . . athlete’s foot . . . canker sores, chicken pox, cold sore, colds, flu, fungal infections, Herpes simplex, MRSA, shingles, warts and viral infections.”
- “Oregano is effective in inactivating MNV (non-enveloped murine norovirus) within 1 hour of exposure. Some of the primary uses for oregano include athlete’s foot, candida, canker sores, Ebola virus, intestinal parasites, MRSA, ringworm, staph infection, viral infections, warts, and whooping cough.”
- “On Guard is a blend of dōTERRA oils and it has been lab tested to decrease symptoms of the flu. Some of the primary uses of On Guard include antiviral, cold sores, colds, flu . . . infection, lupus, MRSA, pneumonia . . . and warts.”
- “Clove has been investigated on Herpes simplex and hepatitis C viruses and was found to be antiviral. Some of the primary uses of clove essential oil include candida, herpes simplex, lupus . . . viral infections, and warts.”
- “Eucalyptus has demonstrated an ability to inhibit the Herpes simplex virus. Some of the primary uses for eucalyptus include Influenza, Measles, Neuralgia, Neuritis, Pneumonia, respiratory viruses rhinitis, shingles, sinusitis and tuberculosis.”
- dōTERRA essential oils have antivirus effects.
- dōTERRA essential oils can treat the symptoms of Ebola virus infection.
- dōTERRA essential oils have anti-cancer properties.
You get the idea. After that letter, the company cracked down, warning its army of Wellness Advocates not to make such claims, but not all listen. Also, consultants have found a way around the FDA, for example, for autism:
In any case, DoTerra salespeople have found a clever workaround. Instead of explicitly touting the oils’ ability to treat autism, salespeople need only share their personal experiences, telling potential customers about, say, the time vetiver helped their child sit through math class, or how a special blend prompted little Billy to hug Grandma for the first time. This sort of anecdotal marketing worries Jeremy Veenstra-VanderWeele, an autism specialist and professor of psychiatry at Columbia University’s medical school. “People sharing their own stories—that does not really tell us much about whether a treatment works,” he says. In fact, there’s no “biological plausibility” for how an essential oil would improve autism symptoms.
Precisely. Anecdotes are confirmation bias writ large, in which people tend to remember things that support their preexisting beliefs and to forget things that don’t. We’re all prone to it; it’s human nature. With respect to confirmation bias, the main difference between skeptics and anyone else is that we’re aware of confirmation bias and consciously try to counter it. (Even then, we don’t always succeed.) Add to that the desire to sell product, and such anecdotes are often highly embellished, either intentionally or subconsciously. Also, people who had a bad (or even just a neutral) experience using essential oils are highly unlikely to become dōTERRA Wellness Advocates. These people are, by definition, true believers whose income depends on selling as many bottles of essential oils as possible and on recruiting as many others as they possibly can to join them. Also, as science communicators know, personal stories are far more powerful persuasion tools than any amount of data, scientific studies, or statistics. Human beings are storytelling apes, and this is how we bond and influence each other—with stories.
Unfortunately, as noted in the same article, there is unlikely to be a crackdown on such companies any time soon, certainly not as long as Donald Trump is President. Indeed, there is even speculation among some dōTERRA Wellness Advocates that they’ll soon be allowed to make health claims again. In the meantime, also in reaction to the FDA’s warning letter, dōTERRA has pivoted to try to manufacture some science supporting the claims made for its products:
After the FDA cautioned DoTerra against making unfounded health claims, the company quietly began to market its products using more scientific language. On a spiffy new website called Source to You, customers can read about DoTerra’s complicated distillation process and its medical advisory board. In August, the company announced plans for a major build-out, including a 39,500-square-foot medical clinic at its Utah headquarters “where we can validate the medical benefits of oils with modern medicine.”
This alliance is not about science or better patient care
Clearly, part of dōTERRA’s strategy to give itself the appearance of scientific respectability and to provide doctors with “scientific evidence” to back up its claims for its essential oils is to make donations like this to cancer centers and other hospitals. St. Elizabeth isn’t even the first:
DoTerra has funded research at Roseman University of Health Sciences in Nevada to study essential oils. In 2018, doTerra donated $5 million to the Huntsman Cancer Foundation in Salt Lake City for the expansion of the cancer hospital at the University of Utah, including its Wellness and Integrative Health Center.
It’s just the one that’s gone the deepest in letting an MLM company influence the healthcare that it’s providing its patients. OF course, whatever clinical trials and basic science studies dōTERRA might fund at St. Elizabeth, the Huntsman Cancer Center, and Roseman University are not really about the science. They’re about marketing, and medical centers, be they academic or private, that accept the funding are complicit in helping a dubious MLM company market its unproven products. St. Elizabeth might benefit from the money that dōTERRA has given it (and will give it in the future), but I bet dōTERRA will benefit more based on increased “respectability” and access to future customers and recruitment of new Wellness Advocates. Its decision to donate to St. Elizabeth was not philanthropic. It was a sound business investment, nothing more.